Healthcare Provider Details

I. General information

NPI: 1841104965
Provider Name (Legal Business Name): JAMES RIVER RETINA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WILKES RIDGE DR STE 100
RICHMOND VA
23233-7963
US

IV. Provider business mailing address

1300 WILKES RIDGE DR STE 100
RICHMOND VA
23233-7963
US

V. Phone/Fax

Practice location:
  • Phone: 804-317-2441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA D RANDOLPH
Title or Position: OWNER
Credential:
Phone: 804-317-2441